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Abstract
Purpose: To analyse the outcomes of concurrent high-dose pulsed intravenous methylprednisolone (IVMP) administered every 3 weeks for 4 cycles along with orbital radiotherapy (OR) in thyroid eye disease (TED).
Study design: Retrospective case series.
Methods: The medical records of 5 patients with moderate-to-severe active TED who underwent concurrent IVMP and OR in 2022 and 2023 were reviewed. All patients received concurrent pulsed IVMP (1 g per day for 3 consecutive days, administered 3-weekly for 4 cycles) and OR (20 Gy in 10 fractions). Improvement was assessed using the Clinical Activity Score (CAS) and International Thyroid Eye Disease (ITEDS) – Vision/Inflammation/Strabismus/Appearance (VISA) scoring system.
Results: The mean age of the 5 patients was 50.2 ± 5.2 years. The mean duration of ophthalmopathy and thyroid disease were 6.2 ± 4.2 months and 9.60 ± 9.29 months, respectively. Following treatment, there was a significant reduction in the mean CAS by 2.8 ± 1.3 (p = 0.009) and ITEDS-VISA scores by 5.8 ± 2.5 (p = 0.006). Improvement in proptosis measured by exophthalmometer was 2.3 ± 1.5 mm (p = 0.028). The mean follow-up duration was 6.0 ± 5.9 months.
Conclusion: Concurrent high-dose three-weekly pulsed IVMP with OR is a safe and effective treatment modality in the management of active TED.